MMC Benefits Handbook
Family Planning
Does the Plan cover infertility treatment?
The Plan covers infertility treatments with a benefit cap of $20,000 for medical services and a separate benefit cap of $20,000 for pharmacy services at:
Under the $1,600 Deductible Plan
- 80% for in-network providers and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $3,200 Deductible Plan
- 70% for in-network providers and 50% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Benefits for infertility treatment are limited to a medical lifetime maximum of $20,000 per person.
Infertility treatments are covered as follows:
- Assisted reproduction procedures (including facility charges and related expenses) due to infertility
- Ovulation induction and monitoring
- Artificial Reproductive Technology (ART)
- In vitro fertilization
- Gamete intrafallopian transfer (GIFT)
- Zygote intrafallopian transfer (ZIFT)
- Cryopreserved embryo transfers
- Intracytoplasmic sperm injection (ICSI) or ovum microsurgery.
- Pre-implementation generic screening (PGS and PGD)
- Creation of an embryo using donor material
- Cryopreservation of mature oocytes is only covered when medically necessary; contact the Claims Administrator for additional information
Artificial insemination is considered an infertility treatment and is limited to the overall infertility medical lifetime maximum of $20,000 per person as noted in the infertility treatment sub-section.
You must obtain preauthorization before receiving infertility treatment.
Prescription drugs related to infertility are covered under the prescription drug benefit and a separate lifetime maximum benefit cap of $20,000 applies for prescription drugs related to infertility.
Is there a program for help navigating the fertility process?
Anthem offers a fertility support program that is administered by WINFertility.
Call Toll Free at +1 844 446 2329 or visit https://managed.winfertility.com/mmc.
Your fertility support through WINFertility offers:
- Benefit consultations and prior authorization of treatment.
- 24/7 access to Nurse Care Managers who provide support and can answer your questions related to:
Are contraceptive devices covered under the Plan?
The Plan covers contraceptive devices under the medical plan at:
Under the $1,600 Deductible Plan
- 100% for in-network providers (no deductible) and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $3,200 Deductible Plan
- 100% for in-network providers (no deductible) and 50% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Oral and injectable contraceptives are covered under the prescription drug plan.
Certain contraceptives are covered under the prescription drug plan including oral and injectable contraceptives as well as contraceptive devices. To check drug coverage, visit www.caremark.com.
Does the Plan cover vasectomy?
The Plan covers vasectomies at:
Under the $1,600 Deductible Plan
- 80% for in-network providers and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $3,200 Deductible Plan
- 70% for in-network providers and 50% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
You must obtain preauthorization before you are admitted to the hospital.
Vasectomy reversals are not covered under the Plan.
Does the Plan cover tubal ligation?
The Plan covers in-patient and outpatient tubal ligation at:
Under the $1,600 Deductible Plan
- 100% for in-network providers with no deductible and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $3,200 Deductible Plan
- 100% for in-network providers with no deductible and 50% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
You must obtain preauthorization before you are admitted to the hospital.
Tubal ligation reversals are not covered.